Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Evidence level and quality rating: Article title: Number: Author(s): Publication date: Journal: Setting: Sample (composition and size): Does this evidence address my EBP question? Yes No-Do not proceed with appraisal of this evidence Is this study: QuaNtitative (collection, analysis, and reporting of numerical data) Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in research, and generalize results from a larger sample population; provides observed effects of a program, problem, or condition, measured precisely, rather than through researcher interpretation of data. Common methods are surveys, face-to-face structured interviews, observations, and reviews of records or documents. Statistical tests are used in data analysis. Go to Section I: QuaNtitative QuaLitative (collection, analysis, and reporting of narrative data) Rich narrative documents are used for uncovering themes; describes a problem or condition from the point of view of those experiencing it. Common methods are focus groups, individual interviews (unstructured or semi structured), and participation/observations. Sample sizes are small and are determined when data saturation is achieved. Data saturation is reached when the researcher identifies that no new themes emerge and redundancy is occurring. Synthesis is used in data analysis. Often a starting point for studies when little research exists; may use results to design empirical studies. The researcher describes, analyzes, and interprets reports, descriptions, and observations from participants. Go to Section II: QuaLitative Mixed methods (results reported both numerically and narratively) Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in combination, provides a better understanding of research problems than using either approach alone. Sample sizes vary based on methods used. Data collection involves collecting and analyzing both quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and can influence stages in the research process. Go to Section III: M ixed M ethods © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 1 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Section I : QuaNtitative Level of Evidence (Study Design) A Is this a report of a single research study?  Yes  No Go to B 1. Was there manipulation of an independent variable?  Yes  No 2. Was there a control group?  Yes  No 3. Were study participants randomly assigned to the intervention and control groups?  Yes  No If Yes to questions 1, 2, and 3, this is a randomized controlled trial (RCT) or experimental study. If Yes to questions 1 and 2 and No to question 3 or Yes to question 1 and No to questions 2 and 3, this is quasi-experimental. (Some degree of investigator control, some manipulation of an independent variable, lacks random assignment to groups, and may have a control group). If No to questions 1, 2, and 3, this is nonexperimental. (No manipulation of independent variable; can be descriptive, comparative, or correlational; often uses secondary data). LEVEL I LEVEL II LEVEL III Study Findings That Help Answer the EBP Question Skip to the Appraisal of QuaNtitative Research Studies section © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 2 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Section I: QuaNtitative (continued) B Is this a summary of multiple sources of research evidence? 1. Does it employ a comprehensive search strategy and rigorous appraisal method? If this study includes research, nonresearch, and experiential evidence, it is an integrative review (see Appendix F).  Yes  No Yes  No Continue  Continue Use Appendix F Use Appendix F 2. For systematic reviews and systematic reviews with meta-analysis (see descriptions below): a. Are all studies included RCTs? LEVEL I b. Are the studies a combination of RCTs and quasi-experimental, or quasi-experimental only? LEVEL II c. Are the studies a combination of RCTs, quasi-experimental, and nonexperimental, or non- experimental only? LEVEL III A systematic review employs a search strategy and a rigorous appraisal method, but does not generate an effect size. A meta-analysis, or systematic review with meta-analysis, combines and analyzes results from studies to generate a new statistic: the effect size. Study Findings That Help Answer the EBP Question Skip to the Appraisal of Systematic Review (With or Without a Meta-Analysis) section © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 3 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Appraisal of QuaNtitative Research Studies Does the researcher identify what is known and not known about the problem and how the study will address any gaps in knowledge?  Yes  No Was the purpose of the study clearly presented?  Yes  No Was the literature review current (most sources within the past five years or a seminal study)?  Yes  No Was sample size sufficient based on study design and rationale?  Yes  No If there is a control group: • Were the characteristics and/or demographics similar in both the control and intervention groups?  Yes  No N/A • If multiple settings were used, were the settings similar?  Yes  No N/A • Were all groups equally treated except for the intervention group(s)?  Yes  No N/A Are data collection methods described clearly?  Yes  No Were the instruments reliable (Cronbach’s α[alpha] > 0.70)?  Yes  No N/A Was instrument validity discussed?  Yes  No N/A If surveys or questionnaires were used, was the response rate > 25%?  Yes  No N/A Were the results presented clearly?  Yes  No If tables were presented, was the narrative consistent with the table content?  Yes  No Were study limitations identified and addressed?  Yes  No Were conclusions based on results?  Yes  No N/A Complete the Quality Rating for QuaNtitative Studies section © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 4 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Appraisal of Systematic Review (With or Without Meta-Analysis) Were the variables of interest clearly identified?  Yes  No Was the search comprehensive and reproducible? • Key search terms stated  Yes  No • Multiple databases searched and identified  Yes  No • Inclusion and exclusion criteria stated  Yes  No Was there a flow diagram that included the number of studies eliminated at each level of review?  Yes  No Were details of included studies presented (design, sample, methods, results, outcomes, strengths, and limitations)?  Yes  No Were methods for appraising the strength of evidence (level and quality) described?  Yes  No Were conclusions based on results?  Yes  No • Results were interpreted  Yes  No • Conclusions flowed logically from the interpretation and systematic review question  Yes  No  Yes  No Did the systematic review include a section addressing limitations and how they were addressed? Complete the Quality Rating for QuaNtitative Studies section (below) Quality Rating for QuaNtitative Studies Circle the appropriate quality rating below: A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate control; definitive conclusions; consistent recommendations based on comprehensive literature review that includes thorough reference to scientific evidence. B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence. C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study design; conclusions cannot be drawn. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 5 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Section II: QuaLitative Level of Evidence (Study Design) A Is this a report of a single research study? Yes this is Level III   No go to II B Study Findings That Help Answer the EBP Question Complete the Appraisal of Single QuaLitative Research Study section (below) Appraisal of a Single QuaLitative Research Study Was there a clearly identifiable and articulated: • Purpose? ❑ Yes ❑No • Research question? ❑ Yes ❑No • Justification for method(s) used? ❑ Yes ❑No • Phenomenon that is the focus of the research? ❑ Yes ❑No Were study sample participants representative? ❑ Yes ❑No Did they have knowledge of or experience with the research area? ❑ Yes ❑No Were participant characteristics described? ❑ Yes ❑No Was sampling adequate, as evidenced by achieving saturation of data? ❑ Yes ❑No Data analysis: • Was a verification process used in every step by checking and confirming ❑ Yes with participants the trustworthiness of analysis and interpretation? ❑No ❑ Yes ❑No Do findings support the narrative data (quotes)? ❑ Yes ❑No Do findings flow from research question to data collected to analysis undertaken? ❑ Yes ❑No Are conclusions clearly explained? ❑ Yes ❑No • Was there a description of how data were analyzed (i.e., method), by computer or manually? Skip to the Quality Rating for QuaLitative Studies section © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 1 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool B For summaries of multiple quaLitative research studies (meta-synthesis), was a comprehensive search strategy and rigorous appraisal method used?  Yes Level III  No go to Appendix F Study Findings That Help Answer the EBP Question Complete the Appraisal of Meta-Synthesis Studies section (below) Appraisal of Meta-Synthesis Studies Were the search strategy and criteria for selecting primary studies clearly defined? ❑ Yes ❑No Were findings appropriate and convincing? ❑ Yes ❑No Was a description of methods used to: • Compare findings from each study? ❑ Yes ❑No ❑ Yes ❑No ❑ Yes ❑No • Interpret data? Did synthesis reflect: • New insights? ❑ Yes ❑No • Discovery of essential features of phenomena? ❑ Yes ❑No • A fuller understanding of the phenomena? ❑ Yes ❑No ❑ Yes ❑No Was sufficient data presented to support the interpretations? Complete the Quality Rating for QuaLititative Studies section (below) © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 2 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Quality Rating for QuaLitative Studies Circle the appropriate quality rating below: No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective process based on the extent to which study data contributes to synthesis and how much information is known about the researchers’ efforts to meet the appraisal criteria. For meta-synthesis, there is preliminary agreement that quality assessments should be made before synthesis to screen out poor-quality studies1. A/B High/Good quality is used for single studies and meta-syntheses2. The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry. Evidence of some or all of the following is found in the report: • Transparency: Describes how information was documented to justify decisions, how data were reviewed by others, and how themes and categories were formulated. • Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple sources to corroborate evidence. • Verification: The process of checking, confirming, and ensuring methodologic coherence. • Self-reflection and self-scrutiny: Being continuously aware of how a researcher’s experiences, background, or prejudices might shape and bias analysis and interpretations. • Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and interpretation give voice to those who participated. • Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature. C Lower-quality studies contribute little to the overall review of findings and have few, if any, of the features listed for High/Good quality. 1 https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALITATIVE_RESEARCH.htm 2 Adapted from Polit & Beck (2017). © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 3 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Section III: Mixed Methods Level of Evidence (Study Design) You will need to appraise both the quaNtitative and quaLitative parts of the study independently, before appraising the study in its entirety. 1. Evaluate the quaNitative part of the study using Section I. Level Quality Level Quality Insert here the level of evidence and overall quality for this part: 2. Evaluate the quaLitative part of the study using Section II. Insert here the level of evidence and overall quality for this part: 3. To determine the level of evidence, circle the appropriate study design: • Explanatory sequential designs collect quaNtitative data first, followed by the quaLitative data; and their purpose is to explain quaNtitative results using quaLitative findings. The level is determined based on the level of the quaNtitative part. • Exploratory sequential designs collect quaLitative data first, followed by the quaNtitative data; and their purpose is to explain quaLitative findings using the quaNtitative results. The level is determined based on the level of the quaLitative part, and it is always Level III. • Convergent parallel designs collect the quaLitative and quaNtitative data concurrently for the purpose of providing a more complete understanding of a phenomenon by merging both datasets. These designs are Level III. • Multiphasic designs collect quaLitative and quaNtitative data over more than one phase, with each phase informing the next phase. These designs are Level III. Study Findings That Help Answer the EBP Question Complete the Appraisal of Mixed Methods Studies section (below) © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 4 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Appraisal of Mixed Methods Studies3 Was the mixed-methods research design relevant to address the quaNtitative and quaLitative research questions (or objectives)? ❑ Yes ❑ No ❑ N/A Was the research design relevant to address the quaNtitative and quaLitative aspects of the mixed-methods question (or objective)? ❑ Yes ❑ No ❑ N/A For convergent parallel designs, was the integration of quaNtitative and quaLitative data (or results) relevant to address the research question or objective? ❑ Yes ❑ No ❑ N/A For convergent parallel designs, were the limitations associated with the integration (for example, the divergence of quaLitative and quaNtitative data or results) sufficiently addressed? ❑ Yes ❑ No ❑ N/A Complete the Quality Rating for Mixed-Method Studies section (below) 3 National Collaborating Centre for Methods and Tools. (2015). Appraising Qualitative, Quantitative, and Mixed Methods Studies included in Mixed Studies Reviews: The MMAT. Hamilton, ON: McMaster University. (Updated 20 July, 2015) Retrieved from http://www.nccmt.ca/ resources/search/232 Quality Rating for Mixed-Methods Studies Circle the appropriate quality rating below A High quality: Contains high-quality quaNtitative and quaLitative study components; highly relevant study design; relevant integration of data or results; and careful consideration of the limitations of the chosen approach. B Good quality: Contains good-quality quaNtitative and quaLitative study components; relevant study design; moderately relevant integration of data or results; and some discussion of limitations of integration. C Low quality or major flaws: Contains low quality quaNtitative and quaLitative study components; study design not relevant to research questions or objectives; poorly integrated data or results; and no consideration of limits of integration. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 5 Johns Hopkins Nursing Evidence-Based Practice Appendix D Evidence Level and Quality Guide Evidence Levels Quality Ratings Level I QuaNtitative Studies Experimental study, randomized controlled trial (RCT) Explanatory mixed method design that includes only a level I quaNtitative study Systematic review of RCTs, with or without metaanalysis Level II B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence. C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study design; conclusions cannot be drawn. QuaLitative Studies Quasi-experimental study Explanatory mixed method design that includes only a level II quaNtitative study Systematic review of a combination of RCTs and quasi-experimental studies, or quasiexperimental studies only, with or without metaanalysis Level III Nonexperimental study Systematic review of a combination of RCTs, quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta-analysis Exploratory, convergent, or multiphasic mixed methods studies Explanatory mixed method design that includes only a level III quaNtitative study QuaLitative study Meta-synthesis A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate control; definitive conclusions; consistent recommendations based on comprehensive literature review that includes thorough reference to scientific evidence. No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective process based on the extent to which study data contributes to synthesis and how much information is known about the researchers’ efforts to meet the appraisal criteria. For meta-synthesis, there is preliminary agreement that quality assessments of individual studies should be made before synthesis to screen out poor-quality studies1. A/B High/Good quality is used for single studies and meta-syntheses2. The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry. Evidence of some or all of the following is found in the report: • Transparency: Describes how information was documented to justify decisions, how data were reviewed by others, and how themes and categories were formulated. • Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple sources to corroborate evidence. • Verification: The process of checking, confirming, and ensuring methodologic coherence. • Self-reflection and scrutiny: Being continuously aware of how a researcher’s experiences, background, or prejudices might shape and bias analysis and interpretations. • Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and interpretation give voice to those who participated. • Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature. C Low quality studies contribute little to the overall review of findings and have few, if any, of the features listed for high/good quality. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing Johns Hopkins Nursing Evidence-Based Practice Appendix D Evidence Level and Quality Guide Quality Ratings Evidence Levels Level IV A High quality: Material officially sponsored by a professional, public, or private organization or a government Opinion of respected authorities and/or nationally recognized expert committees or consensus panels based on scientific evidence Includes: • Clinical practice guidelines • Consensus panels/position statements agency; documentation of a systematic literature search strategy; consistent results with sufficient numbers of well-designed studies; criteria-based evaluation of overall scientific strength and quality of included studies and definitive conclusions; national expertise clearly evident; developed or revised within the past five years B Good quality: Material officially sponsored by a professional, public, or private organization or a government agency; reasonably thorough and appropriate systematic literature search strategy; reasonably consistent results, sufficient numbers of well-designed studies; evaluation of strengths and limitations of included studies with fairly definitive conclusions; national expertise clearly evident; developed or revised within the past five years C Low quality or major flaws: Material not sponsored by an official organization or agency; undefined, poorly defined, or limited literature search strategy; no evaluation of strengths and limitations of included studies, insufficient evidence with inconsistent results, conclusions cannot be drawn; not revised within the past five years Organizational Experience (quality improvement, program or financial evaluation) Level V Based on experiential and nonresearch evidence Includes: • Integrative reviews improvement, financial, or program evaluation methods used; definitive conclusions; consistent recommendations with thorough reference to scientific evidence B Good quality: Clear aims and objectives; consistent results in a single setting; formal quality improvement, • Literature reviews • Quality improvement, program, or financial evaluation • Case reports • Opinion of nationally recognized expert(s) based on experiential evidence A High quality: Clear aims and objectives; consistent results across multiple settings; formal quality financial, or program evaluation methods used; reasonably consistent recommendations with some reference to scientific evidence C Low quality or major flaws: Unclear or missing aims and objectives; inconsistent results; poorly defined quality improvement, financial, or program evaluation methods; recommendations cannot be made Integrative Review, Literature Review, Expert Opinion, Case Report, Community Standard, Clinician Experience, Consumer Preference A High quality: Expertise is clearly evident; draws definitive conclusions; provides scientific rationale; thought leader(s) in the field B Good quality: Expertise appears to be credible; draws fairly definitive conclusions; provides logical argument for opinions C Low quality or major flaws: Expertise is not discernable or is dubious; conclusions cannot be drawn 1 https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALITATIVE_RESEARCH.htm 2 Adapted from Polit & Beck (2017). © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing Johns Hopkins Nursing Evidence-Based Practice Appendix G Individual Evidence Summary Tool Date: Article Number EBP Question: Author and Date Evidence Type Include the study design include your clinical question formulated in your EBP Guideline/Position Statement Paper Sample, Sample Size, Setting Findings That Help Answer the EBP Question if you are including the meta-analysis or meta-synthesis include N/A the number❑ of articles and types of studies included in the researcher's review Observable Measures Limitations Evidence Level, Quality data collection ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A Attach a reference list w ith full citations of articles review ed for this EBP question. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 1 Johns Hopkins Nursing Evidence-Based Practice Appendix G Individual Evidence Summary Tool Date: Article Number EBP Question: Author and Date Evidence Type Sample, Sample Size, Setting Findings That Help Answer the EBP Question Observable Measures Limitations Evidence Level, Quality ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 2 Johns Hopkins Nursing Evidence-Based Practice Appendix G Individual Evidence Summary Tool Directions for Use of the Individual Evidence Summary Tool Purpose This form is used to document the results of evidence appraisal in preparation for evidence synthesis. The form provides the EBP team with documentation of the sources of evidence used, the year the evidence was published or otherwise communicated, the information gathered from each evidence source that helps the team answer the EBP question, and the level and quality of each source of evidence. Article Number Assign a number to each reviewed source of evidence. This organizes the individual evidence summary and provides an easy way to reference articles. Author and Date Indicate the last name of the first author or the evidence source and the publication/communication date. List both author/evidence source and date. Evidence Type Indicate the type of evidence reviewed (e.g., RCT, meta-analysis, mixed methods, quaLitative, systematic review, case study, narrative literature review). Sample, Sample Size, and Setting Provide a quick view of the population, number of participants, and study location. Findings That Help Answer the EBP Question Although the reviewer may find many points of interest, list only findings that directly apply to the EBP question. Observable Measures QuaNtitative measures or variables are used to answer a research question, test a hypothesis, describe characteristics, or determine the effect, impact, or influence. QuaLitative evidence uses cases, context, opinions, experiences, and thoughts to represent the phenomenon of study. Limitations Include information that may or may not be within the text of the article regarding drawbacks of the piece of evidence. The evidence may list limitations, or it may be evident to you, as you review the evidence, that an important point is missed or the sample does not apply to the population of interest. Evidence Level and Quality Using information from the individual appraisal tools, transfer the evidence level and quality rating into this column. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 3 Qualitative Paper Qualitative Paper Criteria This criterion is linked to a Learning OutcomeIntroduction Introductory Paragraph & Thesis Statement: 1. Introduce the topic to the reader in 2-3 sentences to grab the reader's attention. 2. Conclude paragraph with a clear and concise statement informing the reader of the purpose or primary objective of the paper/discussion. Ratings 0.5 pts Met or Exceeds Criteria The information fully addresses the required elements and demonstrates understanding of the material. 0.3 pts Met Minimum Criteria Students met minimum requirements for introduction by including a few attention grabbing statement and a thesis statement. Organization or detail may be lacking. 0.15 pts Did Not Meet Full Criteria Information fails to address the required elements and the introduction or thesis statement may not be included. Pts 0.0 pts Missing Student did not address or poorly addressed introduction in 1 sentence or only included a thesis statement. 0.5 pts Qualitative Paper Criteria This criterion is linked to a Learning OutcomeDescribing Qualitative Research Student summarizes: 1. qualitative research by using support from text books or other peer reviewed resources 2. how and what type of qualitative data would be collected related to your specific POI Ratings 2.5 pts Met or Exceeds Criteria Student fully supported discussion of what qualitative research in using support from text books or peer reviewed resources. Clearly address how and what type of qualitative data would be used related to specific POI. 1.65 pts Met Minimum Criteria Student minimally supported discussion for quantitative research. May or may not have provided adequate support form text books or peer reviewed resources. May be missing the "how" or "what" type of quantitative data would be used related to specific POI. Student fully supported discussion of what qualitative research in using support from text books or peer reviewed resources. Clearly address how and what type of qualitative data would be used related to specific POI. 0.8 pts Did Not Meet Full Criteria Student may or may not have summarized qualitative research using appropriate support from text books or peer reviewed sources OR is lacking a full explanation on how OR what type of qualitative data could be collected related to POI. Pts 0.0 pts Missing Student missing discussion on qualitative research and/or how and what qualitative data would be collected related to POI. Discussion not well supported with text books or peer reviewed resources. 2.5 pts Qualitative Paper Criteria This criterion is linked to a Learning OutcomeCompleting Appraisal Tools Student completes: 1. 2 appraisal tools for both studies 2. All information is completed accurately and correctly 3. Tools are attached with assignment. 4. Appraisal Studies are attached/submitted with the assignment. Ratings 4.0 pts Met or Exceeds Criteria Student completed: 1. Appraisal tools for both studies 2. Accurately and correctly completed tool. 3. Attached tools with assignment. All 3 items must be done for full credit. 3.0 pts Met Minimum Criteria Student completed appraisal tools for both studies. Details and/or accuracy lacking in a few areas. Attached tools with assignment. 2.0 pts Did Not Meet Full Criteria Student failed to: 1. Complete both appraisals for the 2 studies AND/OR 2. Accurately and correctly complete tool. AND/OR 3. Attach tools with assignment. Pts 1.0 pts Missing Student missing: 1. Appraisals on both studies AND/OR 2. Information is not accurate or complete AND/OR 3. Tools not attached with assignment 4.0 pts This criterion is linked to a Learning OutcomeArticle Discussion Using the information from both appraisal tools, discuss in detail the following information: 1. Purpose or phenomenon focus of research and design of study 2. Methodology and data collection: the discussion should include phenomenon or themes discovered, sample of participants or studies included, how selected, if data saturation was used, etc. determination of trustworthiness and credibility, dependability, confirmability and transferability 3. Results, limitations or gaps 4. Level of evidence (directly from tool) 5. Quality of evidence rating (directly from tool) 6. Submit/attach evidence matrix with assignment. All 4 appraised studies should be included on the matrix. 10.0 pts Met or Exceeds Criteria Student demonstrated full understanding of the concepts by including all information as described in the grading criterion. 6.5 pts Met Minimum Criteria Student met minimum criterion requirements. At least 1 of the 6 areas was lacking details to demonstrate full understanding of the material. Information may or may not be fully supported with text books or peer reviewed references or studies. 3.0 pts Did Not Meet Full Criteria Student missing a thorough and indepth discussion showing full understanding of elements in discussion. Failed to meet 2 or more of the required discussion points. AND/OR Not fully supported with detail or information directly from the study, text books or other peer reviewed resources. 0.0 pts Missing Student missing significant detail on one or both discussions of each study's findings or in one or more of the criterion specified. Information not well supported throughout discussion. 10.0 pts -Information should be well supported from findings in the study, peer reviewed resources or text books and should be specific to each study. -Students must apply the above points to each study. -Students must demonstrate understanding of each concept discussed above for full credit. Qualitative Paper Criteria This criterion is linked to a Learning OutcomeApplicability to Practice and Future Research Student should discuss in detail the findings of each study to support a change in practice. The discussion should include: -a review of the steps of the EBP model selected in the forum discussion and what the next step is in implementation -a thorough explanation should detail what is still needed, who would be involved and/or any financial, structural or process changes Student includes peer reviewed references and/or text books to support this discussion. Ratings 5.0 pts Met or Exceeds Criteria Student fully discussed implications to practice from both studies to support how the findings can influence change. The discussion should include the steps in the EBP model and detail stakeholder involvement, financial, structural or process changes needed. This section is fully supported with peer reviewed resources and/or texts. 3.25 pts Met Minimum Criteria Student missing details in one of the criterions: did not fully address steps of EBP model and what the next step is in implementation OR missing details on who is needed, and whether changes would impact financial, structural or process changes. Peer reviewed references or text support may or may not be included. 1.5 pts Did Not Meet Full Criteria Student did not fully discuss implications to practice from both studies to support how the findings can influence change. A review of the EBP model may or may not be included and/or may not be fully supported to include stakeholders, financial, process or structural changes. This section may or may not be fully supported with peer reviewed resources and/or texts. Pts 0.0 pts Missing Student did not discuss in detail the implications to practice for one or both of the studies and/or did not include a detailed discussion of change. A thorough discussion is not provided to demonstrate understanding of next steps of the EBP model and/or stakeholder, financial, structural or process changes needed. Peer reviewed references and/or texts missing from discussion to fully support discussion. 5.0 pts Qualitative Paper Criteria This criterion is linked to a Learning OutcomeConclusion 1. Summarize the major points of the paper in one (1) paragraph. 2. No new information or references should be included in this section. Ratings 0.5 pts Met or Exceeds Criteria The information fully summarizes the main points of the paper/discussion, without including any new information or references. 0.3 pts Met Minimum Criteria Information summarized with minimal detail. 0.15 pts Did Not Meet Full Criteria The information did not adequately summarize the main points of the paper/discussion. New information or references may have been introduced. Pts 0.0 pts Missing Student did not address or poorly addressed in one (1) sentence. 0.5 pts This criterion is linked to a Learning OutcomeScholarship This criterion is linked to a Learning OutcomeScholarship Demonstrate Graduate Level Scholarship. 1. Formal, scholarly writing style, no firstperson language. 2. Writing should be clear and concise. 3. Organize work by headings. 4. Full paper (except reference page, appendices and/or attachments) submitted to Turnitin with minimal similarity. 5. Correctly formatted title page included with running head, page numbers formatted according to APA 7th edition standards. 6. Writing should be free of APA errors. 7. Paper to include a minimum of 2 peerreviewed or scholarly references in addition to required appraisal studies. 8. Citations and references follow 2.5 pts Met or Exceeds Criteria Demonstrates graduate level scholarship with no more than one (1) type of error (the error type may have been repeated multiple times). Faculty discretion will apply. 1.65 pts Met Minimum Criteria Does not demonstrate graduate level scholarship with two (2) to three (3) types of errors (the error type may have been repeated multiple times). Faculty discretion will apply. 0.8 pts Did Not Meet Full Criteria Does not demonstrate graduate level scholarship with four (4) to five (5) types of errors (the error type may have been repeated multiple times). Faculty discretion will apply. 0.0 pts Missing Graduate level scholarship missing with six (6) or more types of errors (the error type may have been repeated multiple times). Faculty discretion will apply. 2.5 pts APA 7th edition format. 9. Writing should be free of grammatical and spelling errors. 10. Paper not to exceed 6 pages excluding title page, reference page and any appendices. 11. Follow all assignments instructions/directions. 12. Additional deductions may apply for late submissions, plagiarism or lack of scholarship and professionalism in the assignment. Qualitative Paper Criteria Total Points: 25.0 Ratings Pts Step 1: Introduction Write an introduction to the topic and end the paragraph with a thesis statement. The introduction should include 2-3 attention grabbing statements and end with 1 concise thesis statement that describes the overall purpose of your paper. Step 2: Describing Qualitative Research Describe what qualitative research is in your own words. Then discuss how and what type of Qualitative Data you would collect related to your POI. For example, if I was interested in knowing what it is like to be a parent in the hospital, then I might decide to interview (how) mothers and fathers of Neonatal Intensive Care Unit patients. I would look for themes (based on data saturation collected in interviews) in their answers until I collected enough information to find trends in the data. I might use that data to then develop new teaching methods to better prepare parents for caring for the baby based on the themes uncovered. Be sure to clearly identify that the information you are gathering is qualitative in nature. Sometimes, you might describe a process that could be used qualitatively or quantitatively, like a questionnaire, so it is important to provide enough information to ensure you are demonstrating a thorough understanding of qualitative literature collection. Step 3: Completing the Appraisal Tools Locate your 2 qualitative studies so you can appraise each separately with the tool below. Students must include one (1) of your studies should be a (Qualitative) metaethnography, meta-study, meta-summary, critical interpretive synthesis, thematic synthesis, systematic review, or meta-synthesis. (Keep in mind that a meta-synthesis is not a literature review, but more of a compilation of findings that are examined, broken down and looked at for similar phenomena, others may refer to them as interpretations of findings).The other study must be a qualitative single study; examples of qualitative single studies include: phenomenology, grounded theory, ethnography, case study, and a narrative analysis. Once you have found 2 different qualitative study designs as specified, complete an appraisal tool for each study using the following link. Only complete the section of the tool related to the qualitative appraisal. • • • • Use this tool to complete the appraisals for both qualitative studies separately. Attach the completed tool to your paper or with your assignment. Appraisal Tool. PDF Appraisal Tool Word Document Follow all steps carefully as the tool will guide you which steps to move to in each section of the tool. For help on how to complete the tool, watch this video. (Links to an external site.) Step 4: Article Discussion Use the information from your appraisal tool to discuss in detail the following information for each study: 1. purpose or phenomenon focus of research and design of the study 2. methodology and data collection: the discussion must include phenomenon or themes discovered, sample of participants or studies included, how selected, if data saturation was used, etc. o determination of trustworthiness and credibility, dependability, confirmability, transferability, o To understand trustworthiness and credibility, check out these links: Trustworthiness and Credibility Video (Links to an external site.) 3. results, limitations or gaps 4. level of evidence according to tool and discuss findings from the study to help you determine this information 5. quality of evidence rating determined by applying evidence from the tool and each study Understanding the levels of evidence tells you about the type of study performed, design, methods, etc. and if those findings should be applied to your own practice area. Grade of Recommendation is important because it helps you make a judgement about the quality of evidence; together they impact the decision about implementation into practice. The following tool can be used to help you determine strength and quality, but this information is also listed directly on the tool. John Hopkins Evidence Rating Scale Be sure that you attach your 2 studies to the paper/assignment. Step 5: Applicability to Practice and Future Research Discuss the findings from each study in practice and how you will use them to make a change. Review your model selected from the Forum Discussion and determine where you are in the next step of the process of implementation. Describe those steps and what is still needed, be sure to consider stakeholders, financial, structural or process changes that may be needed. Step 6: Conclusion Provide a conclusion to the paper summarizing all main points. A conclusion should NOT state any new information that was not previously addressed in the paper. While it can restate the purpose of your writing, it should not repeat the thesis verbatim. Additionally, it should summarize the main points of each section. Step 7: Creating an Evidence Matrix The matrix is a continuation of the matrix you originally submitted in Module 3. Therefore, you will now have 4 studies included on the matrix. Highlight or Bold the NEW studies for the qualitative paper appraisal. You need to correct any mistakes or issues that you may have had with the matrix submitted with the quantitative paper or you will be counted off again on this paper. This document will be used again in 611 if you are in the DNP track, so be sure to put it in a safe place that you will be able to easily find again. See the directions and example Matrix below. Matrix PDF you will need to complete the matrix for this assignment and attach it to the submission. Matrix Word Document Matrix Word Document Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Enter level and quality rating Evidence level and quality rating: Article title: Article Title Number: Article Number Author(s): Publication date: Date Journal: Journal Setting: Setting Sample: Sample composition/size Does this evidence address my EBP question? ☐Yes ☐No-Do not proceed with appraisal of this evidence Is this study: ☐QuaNtitative (collection, analysis, and reporting of numerical data) Measurable data (how many; how much; or how often) used to formulate facts, uncover patterns in research, and generalize results from a larger sample population; provides observed effects of a program, problem, or condition, measured precisely, rather than through researcher interpretation of data. Common methods are surveys, face-to-face structured interviews, observations, and reviews of records or documents. Statistical tests are used in data analysis. Go to Section I: QuaNtitative ☐QuaLitative (collection, analysis, and reporting of narrative data) Rich narrative documents are used for uncovering themes; describes a problem or condition from the point of view of those experiencing it. Common methods are focus groups, individual interviews (unstructured or semi structured), and participation/observations. Sample sizes are small and are determined when data saturation is achieved. Data saturation is reached when the researcher identifies that no new themes emerge and redundancy is occurring. Synthesis is used in data analysis. Often a starting point for studies when little research exists; may use results to design empirical studies. The researcher describes, analyzes, and interprets reports, descriptions, and observations from participants. Go to Section II: QuaLitative ☐Mixed methods (results reported both numerically and narratively) Both quaNtitative and quaLitative methods are used in the study design. Using both approaches, in combination, provides a better understanding of research problems than using either approach alone. Sample sizes vary based on methods used. Data collection involves collecting and analyzing both quaNtitative and quaLitative data in a single study or series of studies. Interpretation is continual and can influence stages in the research process. Go to Section III: Mixed Methods © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 1 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Section I: QuaNtitative Level of Evidence (Study Design) A ☐ Yes ☐ No Go to B 1. Was there manipulation of an independent variable? ☐ Yes ☐ No 2. Was there a control group? ☐ Yes ☐ No 3. Were study participants randomly assigned to the intervention and control groups? ☐ Yes ☐ No Is this a report of a single research study? If Yes to questions 1, 2, and 3, this is a randomized controlled trial (RCT) or experimental study. If Yes to questions 1 and 2 and No to question 3 or Yes to question 1 and No to questions 2 and 3, this is quasi-experimental. (Some degree of investigator control, some manipulation of an independent variable, lacks random assignment to groups, and may have a control group). If No to questions 1, 2, and 3, this is nonexperimental. (No manipulation of independent variable; can be descriptive, comparative, or correlational; often uses secondary data). LEVEL I LEVEL II LEVEL III Study Findings That Help Answer the EBP Question: Enter Text Here Skip to the Appraisal of QuaNtitative Research Studies section © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 2 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Section I: QuaNtitative (continued) B Is this a summary of multiple sources of research evidence? 1. Does it employ a comprehensive search strategy and rigorous appraisal method? ☐Yes Continue ☐Yes If this study includes research, nonresearch, and experiential evidence, it is an integrative review (see Appendix F). Continue ☐No Use Appendix F ☐No Use Appendix F 2. For systematic reviews and systematic reviews with meta-analysis (see descriptions below): a. Are all studies included RCTs? ☐LEVEL I b. Are the studies a combination of RCTs and quasi-experimental, or quasi-experimental only? ☐LEVEL II c. Are the studies a combination of RCTs, quasi-experimental, and nonexperimental, or non- experimental only? ☐LEVEL III A systematic review employs a search strategy and a rigorous appraisal method, but does not generate an effect size. A meta-analysis, or systematic review with meta-analysis, combines and analyzes results from studies to generate a new statistic: the effect size. Study Findings That Help Answer the EBP Question: Enter Text Here Skip to the Appraisal of Systematic Review (With or Without a Meta-Analysis) section © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 3 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Appraisal of QuaNtitative Research Studies Does the researcher identify what is known and not known about the problem and how the study will address any gaps in knowledge? Was the purpose of the study clearly presented? ☐ Yes ☐ Yes ☐ No ☐ No Was the literature review current (most sources within the past five years or a seminal study)? ☐ Yes ☐ No Was sample size sufficient based on study design and rationale? ☐ Yes ☐ No If there is a control group: • Were the characteristics and/or demographics similar in both the control and intervention groups? ☐ Yes ☐ No • If multiple settings were used, were the settings similar? ☐ Yes ☐ No • Were all groups equally treated except for the intervention group(s)? ☐ Yes ☐ No ☐N/A ☐N/A ☐N/A Are data collection methods described clearly? ☐ Yes ☐ No Were the instruments reliable (Cronbach’s [alpha] > 0.70)? ☐ Yes ☐ No ☐N/A Was instrument validity discussed? ☐ Yes ☐ No ☐N/A If surveys or questionnaires were used, was the response rate > 25%? ☐ Yes ☐ No ☐N/A Were the results presented clearly? ☐ Yes ☐ No If tables were presented, was the narrative consistent with the table content? ☐ Yes ☐ No Were study limitations identified and addressed? ☐ Yes ☐ No Were conclusions based on results? ☐ Yes ☐ No ☐N/A Complete the Quality Rating for QuaNtitative Studies section © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 4 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Appraisal of Systematic Review (With or Without Meta-Analysis) Were the variables of interest clearly identified? ☐ Yes ☐ No Was the search comprehensive and reproducible? • Key search terms stated ☐ Yes ☐ No • Multiple databases searched and identified ☐ Yes ☐ No • Inclusion and exclusion criteria stated ☐ Yes ☐ No Was there a flow diagram that included the number of studies eliminated ☐ Yes at each level of review? ☐ No Were details of included studies presented (design, sample, methods, results, outcomes, strengths, and limitations)? ☐ Yes ☐ No Were methods for appraising the strength of evidence (level and quality) ☐ Yes described? ☐ No Were conclusions based on results? ☐ Yes ☐ No • Results were interpreted ☐ Yes ☐ No • Conclusions flowed logically from the interpretation and systematic review question ☐ Yes ☐ No ☐ Yes ☐ No Did the systematic review include a section addressing limitations and how they were addressed? Complete the Quality Rating for QuaNtitative Studies section (below) Quality Rating for QuaNtitative Studies Circle the appropriate quality rating below: A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate control; definitive conclusions; consistent recommendations based on comprehensive literature review that includes thorough reference to scientific evidence. B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence. C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study design; conclusions cannot be drawn. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 5 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Section II: QuaLitative Level of Evidence (Study Design) A Is this a report of a single research study? ☐ Yes ☐ No this is Level III go to II B Study Findings That Help Answer the EBP Question: Enter Text Here Complete the Appraisal of Single QuaLitative Research Study section (below) Appraisal of a Single QuaLitative Research Study Was there a clearly identifiable and articulated: • Purpose? ☐ Yes ☐ No • Research question? ☐ Yes ☐ No • Justification for method(s) used? ☐ Yes ☐ No • Phenomenon that is the focus of the research? ☐ Yes ☐ No Were study sample participants representative? ☐ Yes ☐ No Did they have knowledge of or experience with the research area? ☐ Yes ☐ No Were participant characteristics described? ☐ Yes ☐ No Was sampling adequate, as evidenced by achieving saturation of data? ☐ Yes ☐ No ☐ Yes Data analysis: • Was a verification process used in every step by checking and confirming with participants the trustworthiness of analysis and interpretation? ☐ No ☐ Yes ☐ No Do findings support the narrative data (quotes)? ☐ Yes ☐ No Do findings flow from research question to data collected to analysis undertaken? ☐ Yes ☐ No Are conclusions clearly explained? ☐ Yes ☐ No • Was there a description of how data were analyzed (i.e., method), by computer or manually? Skip to the Quality Rating for QuaLitative Studies section © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 1 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool B For summaries of multiple quaLitative research studies (meta-synthesis), was a comprehensive search strategy and rigorous appraisal method used? ☐ Yes Level III ☐ No go to Appendix F Study Findings That Help Answer the EBP Question: Enter Text Here Complete the Appraisal of Meta-Synthesis Studies section (below) Appraisal of Meta-Synthesis Studies Were the search strategy and criteria for selecting primary studies clearly defined? Were findings appropriate and convincing? Was a description of methods used to: • Compare findings from each study? • Interpret data? Did synthesis reflect: • New insights? • Discovery of essential features of phenomena? • A fuller understanding of the phenomena? Was sufficient data presented to support the interpretations? ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No Complete the Quality Rating for QuaLititative Studies section (below) © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 2 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Quality Rating for QuaLitative Studies Select the appropriate quality rating below: No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective process based on the extent to which study data contributes to synthesis and how much information is known about the researchers’ efforts to meet the appraisal criteria. For meta-synthesis, there is preliminary agreement that quality assessments should be made before synthesis to screen out poor-quality studies1. ☐A/B High/Good quality is used for single studies and meta-syntheses2. The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry. Evidence of some or all of the following is found in the report: • Transparency: Describes how information was documented to justify decisions, how data were reviewed by others, and how themes and categories were formulated. • Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple sources to corroborate evidence. • Verification: The process of checking, confirming, and ensuring methodologic coherence. • Self-reflection and self-scrutiny: Being continuously aware of how a researcher’s experiences, background, or prejudices might shape and bias analysis and interpretations. • Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and interpretation give voice to those who participated. • Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature. ☐C Lower-quality studies contribute little to the overall review of findings and have few, if any, of the features listed for High/Good quality. 1 https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALITATIVE_RESEARCH.htm 2 Adapted from Polit & Beck (2017). © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 3 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Section III: Mixed Methods Level of Evidence (Study Design) You will need to appraise both the quaNtitative and quaLitative parts of the study independently, before appraising the study in its entirety. 1. Evaluate the quaNitative part of the study using Section I. Level Quality Level Quality Level Quality Level Quality Insert here the level of evidence and overall quality for this part: 2. Evaluate the quaLitative part of the study using Section II. Insert here the level of evidence and overall quality for this part: 3. To determine the level of evidence, circle the appropriate study design: • Explanatory sequential designs collect quaNtitative data first, followed by the quaLitative data; and their purpose is to explain quaNtitative results using quaLitative findings. The level is determined based on the level of the quaNtitative part. • Exploratory sequential designs collect quaLitative data first, followed by the quaNtitative data; and their purpose is to explain quaLitative findings using the quaNtitative results. The level is determined based on the level of the quaLitative part, and it is always Level III. • Convergent parallel designs collect the quaLitative and quaNtitative data concurrently for the purpose of providing a more complete understanding of a phenomenon by merging both datasets. These designs are Level III. • Multiphasic designs collect quaLitative and quaNtitative data over more than one phase, with each phase informing the next phase. These designs are Level III. Study Findings That Help Answer the EBP Question: Enter Text Here Complete the Appraisal of Mixed Methods Studies section (below) © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 4 Johns Hopkins Nursing Evidence-Based Practice Appendix E Research Evidence Appraisal Tool Appraisal of Mixed Methods Studies 3 Was the mixed-methods research design relevant to address the quaNtitative and quaLitative research questions (or objectives)? ☐ Yes ☐ No ☐N/A Was the research design relevant to address the quaNtitative and quaLitative aspects of the mixed-methods question (or objective)? ☐ Yes ☐ No ☐N/A For convergent parallel designs, was the integration of quaNtitative and quaLitative data (or results) relevant to address the research question or objective? ☐ Yes ☐ No ☐N/A For convergent parallel designs, were the limitations associated with the integration (for example, the divergence of quaLitative and quaNtitative data or results) sufficiently addressed? ☐ Yes ☐ No ☐N/A Complete the Quality Rating for Mixed-Method Studies section (below) 3 National Collaborating Centre for Methods and Tools. (2015). Appraising Qualitative, Quantitative, and Mixed Methods Studie s included in Mixed Studies Reviews: The MMAT. Hamilton, ON: McMaster University. (Updated 20 July, 2015) Retrieved from http://www.nccmt.ca/ resources/search/232 Quality Rating for Mixed-Methods Studies Circle the appropriate quality rating below A High quality: Contains high-quality quaNtitative and quaLitative study components; highly relevant study design; relevant integration of data or results; and careful consideration of the limitations of the chosen approach. B Good quality: Contains good-quality quaNtitative and quaLitative study components; relevant study design; moderately relevant integration of data or results; and some discussion of limitations of integration. C Low quality or major flaws: Contains low quality quaNtitative and quaLitative study components; study design not relevant to research questions or objectives; poorly integrated data or results; and no consideration of limits of integration. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 5 Johns Hopkins Nursing Evidence-Based Practice Appendix G Individual Evidence Summary Tool Date: Article Number EBP Question: Author and Date Evidence Type Include the study design include your clinical question formulated in your EBP Guideline/Position State ment Paper Sample, Sample Size, Setting Findings That Help Answer the EBP Question if you are including the meta-analysis or meta-synthesis include N/A the number❑ of articles and types of studies included in the researcher's review Observable Measures Limitations Evidence Level, Quality data collection ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A Attach a reference list w ith full citations of articles review ed for this EBP question. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 1 Johns Hopkins Nursing Evidence-Based Practice Appendix G Individual Evidence Summary Tool Date: Article Number EBP Question: Author and Date Evidence Type Sample, Sample Size, Setting Findings That Help Answer the EBP Question Observable Measures Limitations Evidence Level, Quality ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 2 Johns Hopkins Nursing Evidence-Based Practice Appendix G Individual Evidence Summary Tool Directions for Use of the Individual Evidence Summary Tool Purpose This form is used to document the results of evidence appraisal in preparation for evidence synthesis. The form provides the EBP team with documentation of the sources of evidence used, the year the evidence was published or otherwise communicated, the information gathered from each evidence source that helps the team answer the EBP question, and the level and quality of each source of evidence. Article Number Assign a number to each reviewed source of evidence. This organizes the individual evidence summary and provides an easy way to reference articles. Author and Date Indicate the last name of the first author or the evidence source and the publication/communication date. List both author/evidence source and date. Evidence Type Indicate the type of evidence reviewed (e.g., RCT, meta-analysis, mixed methods, quaLitative, systematic review, case study, narrative literature review). Sample, Sample Size, and Setting Provide a quick view of the population, number of participants, and study location. Findings That Help Answer the EBP Question Although the reviewer may find many points of interest, list only findings that directly apply to the EBP question. Observable Measures QuaNtitative measures or variables are used to answer a research question, test a hypothesis, describe characteristics, or determine the effect, impact, or influence. QuaLitative evidence uses cases, context, opinions, experiences, and thoughts to represent the phenomenon of study. Limitations Include information that may or may not be within the text of the article regarding drawbacks of the piece of evidence. The evidence may list limitations, or it may be evident to you, as you review the evidence, that an important point is missed or the sample does not apply to the population of interest. Evidence Level and Quality Using information from the individual appraisal tools, transfer the evidence level and quality rating into this column. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 3 Johns Hopkins Nursing Evidence-Based Practice Appendix D Evidence Level and Quality Guide Evidence Levels Quality Ratings Level I QuaNtitative Studies Experimental study, randomized controlled trial (RCT) Explanatory mixed method design that includes only a level I quaNtitative study Systematic review of RCTs, with or without metaanalysis Level II B Good quality: Reasonably consistent results; sufficient sample size for the study design; some control, fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence. C Low quality or major flaws: Little evidence with inconsistent results; insufficient sample size for the study design; conclusions cannot be drawn. QuaLitative Studies Quasi-experimental study Explanatory mixed method design that includes only a level II quaNtitative study Systematic review of a combination of RCTs and quasi-experimental studies, or quasiexperimental studies only, with or without metaanalysis Level III Nonexperimental study Systematic review of a combination of RCTs, quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta-analysis Exploratory, convergent, or multiphasic mixed methods studies Explanatory mixed method design that includes only a level III quaNtitative study QuaLitative study Meta-synthesis A High quality: Consistent, generalizable results; sufficient sample size for the study design; adequate control; definitive conclusions; consistent recommendations based on comprehensive literature review that includes thorough reference to scientific evidence. No commonly agreed-on principles exist for judging the quality of quaLitative studies. It is a subjective process based on the extent to which study data contributes to synthesis and how much information is known about the researchers’ efforts to meet the appraisal criteria. For meta-synthesis, there is preliminary agreement that quality assessments of individual studies should be made before synthesis to screen out poor-quality studies1. A/B High/Good quality is used for single studies and meta-syntheses2. The report discusses efforts to enhance or evaluate the quality of the data and the overall inquiry in sufficient detail; and it describes the specific techniques used to enhance the quality of the inquiry. Evidence of some or all of the following is found in the report: • Transparency: Describes how information was documented to justify decisions, how data were reviewed by others, and how themes and categories were formulated. • Diligence: Reads and rereads data to check interpretations; seeks opportunity to find multiple sources to corroborate evidence. • Verification: The process of checking, confirming, and ensuring methodologic coherence. • Self-reflection and scrutiny: Being continuously aware of how a researcher’s experiences, background, or prejudices might shape and bias analysis and interpretations. • Participant-driven inquiry: Participants shape the scope and breadth of questions; analysis and interpretation give voice to those who participated. • Insightful interpretation: Data and knowledge are linked in meaningful ways to relevant literature. C Low quality studies contribute little to the overall review of findings and have few, if any, of the features listed for high/good quality. © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing Johns Hopkins Nursing Evidence-Based Practice Appendix D Evidence Level and Quality Guide Quality Ratings Evidence Levels Level IV A High quality: Material officially sponsored by a professional, public, or private organization or a government Opinion of respected authorities and/or nationally recognized expert committees or consensus panels based on scientific evidence Includes: • Clinical practice guidelines • Consensus panels/position statements agency; documentation of a systematic literature search strategy; consistent results with sufficient numbers of well-designed studies; criteria-based evaluation of overall scientific strength and quality of included studies and definitive conclusions; national expertise clearly evident; developed or revised within the past five years B Good quality: Material officially sponsored by a professional, public, or private organization or a government agency; reasonably thorough and appropriate systematic literature search strategy; reasonably consistent results, sufficient numbers of well-designed studies; evaluation of strengths and limitations of included studies with fairly definitive conclusions; national expertise clearly evident; developed or revised within the past five years C Low quality or major flaws: Material not sponsored by an official organization or agency; undefined, poorly defined, or limited literature search strategy; no evaluation of strengths and limitations of included studies, insufficient evidence with inconsistent results, conclusions cannot be drawn; not revised within the past five years Organizational Experience (quality improvement, program or financial evaluation) Level V Based on experiential and nonresearch evidence Includes: • Integrative reviews improvement, financial, or program evaluation methods used; definitive conclusions; consistent recommendations with thorough reference to scientific evidence B Good quality: Clear aims and objectives; consistent results in a single setting; formal quality improvement, • Literature reviews • Quality improvement, program, or financial evaluation • Case reports • Opinion of nationally recognized expert(s) based on experiential evidence A High quality: Clear aims and objectives; consistent results across multiple settings; formal quality financial, or program evaluation methods used; reasonably consistent recommendations with some reference to scientific evidence C Low quality or major flaws: Unclear or missing aims and objectives; inconsistent results; poorly defined quality improvement, financial, or program evaluation methods; recommendations cannot be made Integrative Review, Literature Review, Expert Opinion, Case Report, Community Standard, Clinician Experience, Consumer Preference A High quality: Expertise is clearly evident; draws definitive conclusions; provides scientific rationale; thought leader(s) in the field B Good quality: Expertise appears to be credible; draws fairly definitive conclusions; provides logical argument for opinions C Low quality or major flaws: Expertise is not discernable or is dubious; conclusions cannot be drawn 1 https://www.york.ac.uk/crd/SysRev/!SSL!/WebHelp/6_4_ASSESSMENT_OF_QUALITATIVE_RESEARCH.htm 2 Adapted from Polit & Beck (2017). © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing
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